Jean-Yves Fagon, MD; Jean Chastre, MD
Fagon J., Chastre J.; Management of Suspected Ventilator-Associated Pneumonia. Ann Intern Med. 2000;133:1009. doi: 10.7326/0003-4819-133-12-200012190-00021
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Published: Ann Intern Med. 2000;133(12):1009.
In critically ill patients, fiberoptic bronchoscopy is well tolerated as long as usual contraindications are respected (1). In our study, no severe deleterious effects occurred. Different diagnostic techniques, including nondirected mini-bronchoalveolar lavage, have been tried, with apparently acceptable results. These “intermediate” techniques may reduce costs and simplify the procedure; unfortunately, in the absence of clear confirmation of preliminary findings, they cannot be recommended as the cornerstones of a diagnostic strategy. We agree with Dr. Johnson that semi-quantitative cultures can be considered an acceptable alternative microbiological technique to quantitative cultures for distinguishing colonizing pathogens from infecting pathogens. The approach tested by Singh and associates on a subgroup of patients with a low probability of ventilator-associated pneumonia (2), which was based on periodic systematic clinical reevaluation, merits prospective analysis in a large study sample.
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